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892 DISEASES OF THE DENTAL PULP, AND TEEATMENT. ;
dently due to a large amount of vitality in the individual, giving a
resisting power to the encroachment of disease. This peculiarity is
often manifested in the power of resistance some pulps possess against
the action of arsenic. Ordinarily, however, superficial pulpitis is of but
short duration, and, following the general law, continues to the destruc-
tion of the whole organ. The possible error in diagnosis will be found
in the difficultv of determining the extent of the lesion and ^vhether it
may not possiblv have reached the condition of deep-seated pulpitis, the
latter condition being generally accompanied by more or less periosteal
disturbance, which will at times furnish a guide to judgment, though
the violence of the inflammation will have to be the general diagnostic
sign. If there is but little activity, if pain is not excessive and is not
coupled with periostitis, the pulpitis may be regarded as superficial
but, on the other hand, if acute with the other accompaniments, it has
reached a point where devitalization is certain to result, and any effort
to abort the inflammatory state must result in failure. The usual
attempt to quiet such pulps and then cap with some foreign material
has but little to recommend it, and the final result is almost invari-
ably devitalization.
The destruction of the life of the pulp is by no means dependent on
exposure by caries. The organ holds its vitality by the slight connec-
tions with the main vessels and nerves through the oftentimes very con-
tracted canal, the apical foramen of the tooth. It requires but a very
slight disturbance at this. point to cut oif all sources of nutrition in this
direction, and the pulp's life is sacrificed. This is much more easily
accomplished than is generally supposed, judging by the very rough
appliances, and the still rougher modes of using them, that have been
adopted from time to time for the purpose of moving teeth. The sepa-
ration of teeth by the wedge and hammer and powerful screws is but
one sample of the wrong application of force upon a delicate tissue.
Tiie elasticity of the pericementum admits of a limited movement, and
any force used beyond that must be cautiously applied, to jirevent
strangulation of the vessels of the pulp at the apex. The pulp may
be devitalized and give no immediate sign, or it may result in sudden
congestion or rapid discoloration. A sudden blow has the same eflect,
and, as this is peculiarly liable to occur to children, the largest percent-
age of loss from this cause occurs in the earlier years of life and very
frecpiently fails of recognition until a later period, when discoloration
gives the usual indication. Devitalization occurring under these cir-
cumstances is not necessarily a source of discomfort to the individual.
Tiie pulp-tissue is gradually decomposed or mummified, and the matter
is gradually absorbed into the body of the tooth, and, in connection
with the dead material already there, produces the dark appearance
before alluded to. Such a tooth may remain comparatively comfortable
for years. It recpiires the ingress of atmospheric germs to produce
the j)n)ducts of decomposition which render the treatment the mo^t
troublesome and uncertain of any of the pathological conditions of
which the dentist is called to take charge. This can be more properly
considered under
Gangrene.—This term is applied to the pulp in the last stages of
892 DISEASES OF THE DENTAL PULP, AND TEEATMENT. ;
dently due to a large amount of vitality in the individual, giving a
resisting power to the encroachment of disease. This peculiarity is
often manifested in the power of resistance some pulps possess against
the action of arsenic. Ordinarily, however, superficial pulpitis is of but
short duration, and, following the general law, continues to the destruc-
tion of the whole organ. The possible error in diagnosis will be found
in the difficultv of determining the extent of the lesion and ^vhether it
may not possiblv have reached the condition of deep-seated pulpitis, the
latter condition being generally accompanied by more or less periosteal
disturbance, which will at times furnish a guide to judgment, though
the violence of the inflammation will have to be the general diagnostic
sign. If there is but little activity, if pain is not excessive and is not
coupled with periostitis, the pulpitis may be regarded as superficial
but, on the other hand, if acute with the other accompaniments, it has
reached a point where devitalization is certain to result, and any effort
to abort the inflammatory state must result in failure. The usual
attempt to quiet such pulps and then cap with some foreign material
has but little to recommend it, and the final result is almost invari-
ably devitalization.
The destruction of the life of the pulp is by no means dependent on
exposure by caries. The organ holds its vitality by the slight connec-
tions with the main vessels and nerves through the oftentimes very con-
tracted canal, the apical foramen of the tooth. It requires but a very
slight disturbance at this. point to cut oif all sources of nutrition in this
direction, and the pulp's life is sacrificed. This is much more easily
accomplished than is generally supposed, judging by the very rough
appliances, and the still rougher modes of using them, that have been
adopted from time to time for the purpose of moving teeth. The sepa-
ration of teeth by the wedge and hammer and powerful screws is but
one sample of the wrong application of force upon a delicate tissue.
Tiie elasticity of the pericementum admits of a limited movement, and
any force used beyond that must be cautiously applied, to jirevent
strangulation of the vessels of the pulp at the apex. The pulp may
be devitalized and give no immediate sign, or it may result in sudden
congestion or rapid discoloration. A sudden blow has the same eflect,
and, as this is peculiarly liable to occur to children, the largest percent-
age of loss from this cause occurs in the earlier years of life and very
frecpiently fails of recognition until a later period, when discoloration
gives the usual indication. Devitalization occurring under these cir-
cumstances is not necessarily a source of discomfort to the individual.
Tiie pulp-tissue is gradually decomposed or mummified, and the matter
is gradually absorbed into the body of the tooth, and, in connection
with the dead material already there, produces the dark appearance
before alluded to. Such a tooth may remain comparatively comfortable
for years. It recpiires the ingress of atmospheric germs to produce
the j)n)ducts of decomposition which render the treatment the mo^t
troublesome and uncertain of any of the pathological conditions of
which the dentist is called to take charge. This can be more properly
considered under
Gangrene.—This term is applied to the pulp in the last stages of
